The ACHIEVE Trial: Achieving Longer Gestation in Preeclampsia Via Antihypertensive Therapy.

The Achieve Trial is a randomized clinical trial to test whether lowering blood pressure to less than 140/90 mmHg in women with preeclampsia will prolong pregnancy.

Inclusion Criteria:Pregnant womenGestational age: 23 weeks, 0 days to 35 weeks, 6 daysPreeclampsia, the non-severe form at enrollment, which is called without severe features by the American College of Obstetricians and Gynecologists.No evidence of the severe form of preeclampsia, termed severe features, as outlined in maternal exclusionsNo indication for delivery at the time of enrollment.Planned expectant management at time of enrollmentSingleton gestation - defined as one fetus in utero at and beyond 14 weeks gestation. (A pregnancy complicated by a vanishing twin in the first trimester defined as less than 14 weeks gestation will be eligible.)Dating sonogram at less than 21 weeks of gestationPrenatal care, or another healthcare visit with a documented blood pressure, at less than 21 weeks gestationIntact membranesExclusion Criteria:Preeclampsia with severe features, defined per ACOG as:Systolic blood pressure of 160 mm Hg or more, or diastolic blood pressure of 110 mm Hg or more on two occasions at least 4 hours apart (unless antihypertensive therapy is initiated before this time)Thrombocytopenia defined as: lower than 100 x 10e9 platelets/LImpaired liver function that is not accounted for by alternative diagnoses and as indicated by abnormally elevated blood concentrations of liver enzymes (to more than twice the upper limit normal concentrations), or by severe persistent right upper quadrant or epigastric pain unresponsive to medicationsRenal insufficiency (serum creatinine concentration more than 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease)Pulmonary edemaNew-onset headache unresponsive to medication and not accounted for by alternative diagnosesVisual disturbancesUnderlying renal dysfunction defined as, presenting the following parameters prior to 20 weeks gestation: baseline creatinine, equal to or higher than, 1.2 mg/dL Or proteinuria: defined as presenting protein in urine, equal to or higher than, 300 mg/24 hours or protein/creatinine ratio, equal to or higher than, 0.3 or Urine dipstick reading of greater than or equal to 2 at baseline and in the absence of a urinary tract infectionSystemic Lupus erythematosusLabetalol contraindications according to the FDA package insert, which are defined as follows:+Bronchial asthma, cardiac failure, greater-than-first-degree heart block, cardiogenic shock, severe bradycardia defined as heart rate lower than 60 beats per minute, other conditions associated with severe and prolonged hypotension, pheochromocytoma, patients with a history of hypersensitivity to any component of the productPatient unable to or unwilling to adhere to management recommendationsFetal Reasons for Study Ineligibility:Fetal growth restriction (lower than 10th percentile) at enrollment, based on an ultrasound within 3 weeks prior to enrollmentOligohydramnios defined by amniotic fluid volume lower than 5 cm, based on an ultrasound within the 48 hours prior to enrollmentKnown major structural or chromosomal abnormality